HIM Coding Lead

  • Requisition ID: 177587
  • Department: 100738 Facility Coding
  • Schedule: Full Time - Eligible for Benefits
  • Shift: Day
  • Category: Clerical & Administrative Support
  • Salary:$31.19 - $43.68

Position Purpose

The Lead Coding position is accountable for the responding to escalations from internal coding staff as well as external departments and costumers to ensure compliance and revenue related to reimbursement is coded and billed within appropriate timelines. This position is responsible for maintain departmental standard work and keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations. This incumbent is to have expert knowledge of accurately assigning ICD-10-CM diagnostic and procedure codes for all aspects of professional services coding or facility coding.

 

 

 

Nature and Scope

Incumbent will also perform highly complex and specialized coding, including review analysis. The major challenge of this position is ensuring the accountable coding for each patient type is completed within designated timelines. This position is challenged to keep workflows running smoothly for the department, including charge related items in work queues to ensure correct and timely billing. This position is accountable to bring issues and the need for revised/additional policies and procedures to management’s attention.

 

This candidate must be able to identify and resolve problems, set goals and priorities, and represent the department in a professional manner as well as in the absence of Leadership, as assigned. High standards of performance, courteousness, diplomacy, and respect for confidentiality are essential.

 

Specific job responsibilities by section include;

 

HIM Coding Lead (Facility):

This list is to include but is not limited to coding and resolving escalations regarding; Acute Inpatient/Outpatient, Level II Trauma, Inpatient Rehab Facility, Home Health, Hospice and Hospital Outpatient Departments. Feedback and correction of ICD-10-CM/PCS and CPT code assignments, corrections and advice must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

 

HIM Coding Lead (Professional Services):

This list is to include but is not limited to coding and resolving escalations regarding; Renown Primary Care and Specialty Care Groups, Acute Inpatient/Outpatient, Trauma and Inpatient Rehab. Feedback and correction of ICD-10-CM, CPT, HCPCS, E & M code assignments and modifiers, corrections and advice must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

 

Assignment of diagnostic codes by proficient analysis and translation of diagnostic statements, physician orders, and other pertinent documentation leading to coding accuracy and abstracting of pertinent data elements from documentation provided.

 

Incumbent must have skill set to:

• Addresses appeals and complex medical record review needed for insurance denials to facilitate expedient resolution and reimbursement.

• Participates in mandated Medical Record Review processes.

• Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.

• Ensures that all factors necessary for assigning accurate DRG, ICD-10 CM, ICD-10 PCS and/or CPT, HCPCS, E & M and modifiers are present, and that related diagnoses are ranked properly when applicable.

• Assign accurate present on admission indicators when applicable.

• Provides information and responds to inquiries regarding medical documentation and DRG’s, PSI’s and HAC’s to CDI staff including Utilization and Quality Assurance Departments when needed.

• Knowledge of discharge disposition and reimbursement outcomes.

 

To appropriately and accurately translate diagnoses, contact with appropriate charging departments and healthcare providers may be required to acquire or clarify necessary information.

 

As the Lead Coder, the ability to assist all coders with coding inquiries is essential. In addition, the Lead Coder must acquire the ability to proficiently identify and troubleshoot EMR coding queues and encoder workflows consistent with requirements of the HIM Leadership and in collaboration with the Central Business Office and/or Revenue Integrity Department.

 

When documentation is incomplete, vague, or ambiguous, it is the responsibility of incumbent to work in conjunction with department Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable sign, symptom, or diagnosis and/or physician order. Other responsibilities include:

 

• Adherence to Health Information Management (HIM) Coding policies.

• Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy.

• Responsibility for maintaining coding certification and referencing current ICD-10 coding guidelines and regulatory changes.

• Participates in performance improvement initiatives as assigned.

 

This position will also be involved in collaboration and teamwork with Clinical Documentation Improvement Department, Quality, Revenue Integrity, Departmental Leadership and Renown employed and credentialed providers.

 

The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.

 

Telecommuting is allowed with approval from HIM Management.

 

KNOWLEDGE, SKILLS & ABILITIES

 

1. Knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS’ Official Guidelines for Coding and Reporting ICD-10-CM coding.

2. Incumbent must have thorough knowledge of Anatomy and Physiology of the human body, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.

3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.

4. Ability to troubleshoot EMR coder queues and report issues to HIM Coding Leadership.

5. Knowledge of clinical content standards.

 

This position does not provide patient care.

 

 

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

 

 

 

Minimum Qualifications
Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelors Degree in Health Information Management is preferred.

Experience:

A minimum of 10 or more years of progressively responsible and advanced experience in health care coding (facility or professional services) . Experience in all patient types as well as experience and knowledge of needed compliance criteria for all facility types is required.

License(s):

None

Certification(s):

AAPC, AHIMA or Certified Coding credential (excludes apprenticeship classification)

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

 

 

Benefits

Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.

With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.

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    Education Assistance

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    Paid Time Off

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    401(k) Company Match

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    Flexibile Work Environment